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It’s an honor no American metropolis would fight for: The City That Bites You Back.

But in any race, there’s a loser as well as a winner, and Philadelphia tops this year’s list of the most bed bug-infested cities in the U.S. Terminix, the world’s largest pest control company, annually ranks major cities based on the number of infestations confirmed by their staff. This year’s rankings have Cincinnati coming in second and New York City — the most-infested city for the past two years — coming in third. Cleveland, Miami, Houston, Indianapolis and New Haven joined the top 15 this year.

Bed bugs (Cimex lectularius L.) are parasites that feed on human blood and prefer to live in beds or other household furniture. Victims are often attacked in their sleep, unaware that they are being bitten.

Symptoms of bed bug attacks include itchy red welts on the skin and, for some patients, allergic reactions triggered by the insects’ saliva. Because the bites remove some of the victim’s blood, prolonged exposure can in rare cases lead to anemic conditions.

Terminix warns that the national bed bug epidemic, which began a few years ago, will likely spread to more cities as pests hitch rides with unknowing summer travelers. To be on guard against the pests, the company advises travelers to check hotel mattresses, headboards and box springs for bugs, bug exoskeletons and dark blood spots. To avoid picking up the parasites, you should hang all your clothing — don’t store any items in drawers or lay them out on the bed or furniture. Luggage should be kept on the luggage rack or as far away from the floor as possible.

To avoid spreading the bugs after a possible exposure, travelers should immediately vacuum their suitcases and wash their clothing in hot water upon returning home. In neighborhoods already known to be infested, it might be advisable to take even more defensive measures, such as covering mattresses and box springs with a bug-proof plastic cover.

If you think you’ve contracted bed bugs, better call an exterminator: bed bugs are notoriously difficult to get rid of on your own. As TIME reported last week, consumer “bug bombs” or “foggers” have been proven to be ineffective in exterminating the insects and can even make an infestation worse. As TIME reported last year, consumers often overuse home pesticides, which can cause illness and even death.